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2005-030
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2005-030
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Last modified
7/5/2016 2:27:35 PM
Creation date
9/30/2015 7:40:02 PM
Metadata
Fields
Template:
Official Documents
Official Document Type
Addendum
Approved Date
01/18/2005
Control Number
2005-030
Agenda Item Number
11.D.1
Entity Name
Blue Cross and Blue Shield of Florida
Symetra :Life Insurance Co.
Subject
HIPAA-AS Addendum to Agreement
Archived Roll/Disk#
4000
Supplemental fields
SmeadsoftID
3862
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PHI may be disclosed for any purpose if an authorization that satisfies all of HIPAA ' s <br /> requirements for a valid authorization is provided by the participant . All uses and <br /> disclosures made pursuant to a signed authorization must be consistent with the terms <br /> and conditions of the authorization . <br /> 9 . Complying With the " Minimum-Necessary " Standard <br /> HIPAA requires that when PHI is used or disclosed, the amount disclosed generally <br /> must be limited to the "minimum necessary" to accomplish the purpose - of the use or <br /> disclosure . <br /> • For each of the following recurring disclosures . <br /> benefit enrollment /changes , audits , . claim resolution, obtaining identification <br /> cards , and responding to legal requests , the identifiers will be as follows : social <br /> security, medical records , account and health plan beneficiary numbers , names , <br /> geographic units , dates , ages over 89 , phone/fax numbers , email addresses and any <br /> other unique identifiers . The persons who may receive the PHI will be account <br /> representatives , claims adjusters , attorneys , . nurses , physicians , managers , <br /> supervisors , auditors , underwriters , insurance brokers , and the Human Resource <br /> designated staff. The conditions will be as follows : <br /> • determination of eligibility, coverage and cost sharing amounts (for example , cost <br /> of a benefit, plan maximums and co -payments as determined for an individuals <br /> claim) ; <br /> • coordination of benefits ; <br /> • adjudication of health benefit claims (including appeals and other payment <br /> disputes) , <br /> • subrogation of health benefit claims , <br /> • establishing employee contributions , <br /> • risk adjusting amounts due based on enrollee health status and demographic <br /> characteristics <br /> • billing , collection activities and related health care data processing; <br /> • claims management and related health care data processing, including auditing <br /> payments , investigating and resolving payment disputes , and responding to <br /> participant inquiries about payments ; <br /> • obtaining payment under a contract for reinsurance (including stop - loss and excess <br /> of loss insurance) ; <br /> • medical necessity reviews or reviews of appropriateness of care justification of <br /> charges , <br /> • utilization review, including pre-certification, preauthorization, concurrent review <br /> and retrospective review ; <br /> • disclosure to consumer reporting agencies related to the collection of premiums or <br /> reimbursement (the following PHI may be disclosed for payment purposes ; name <br /> and address , date of birth, Social Security number, payment history, account <br /> number, and name and address of the provider and/or health plan) . <br /> 11 <br />
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